Quality health care and patient safety have emerged as major concerns in society. Simulation is a key approach to improving patient safety, supplementing the haphazard experiences of clinicians with systematic guided experiences that replicate substantial aspects of the real world in a fully interactive manner. Simulation is especially useful for training medical students and residents, ensuring that they reach the desired level of competency before performing procedures and surgery on real patients. Neurosurgical procedures, particularly cranial applications, lend themselves well to virtual reality (VR) simulation. The complexity and compactness of cerebral structures allows little room for error, making the need for skill-set acquisition prior to a procedure crucial. Ventriculostomy is a standard neurosurgical procedure for measuring the intracranial pressure (ICP) as well as for providing therapeutic cerebrospinal fluid drainage to lower the ICP in situations such as traumatic brain injury and tumors. In academic medical centers this procedure is performed predominantly by neurosurgical residents in their second to fourth year of training. The present study aims to develop and evaluate an innovative instructional and assessment program using [unreadable] simulation to improve the ability of neurosurgery residents to perform a ventriculostomy. We will develop a library of virtual brains using the ImmersiveTouch(tm) workstation, a head- and hand-tracked, high resolution, high performance VR and haptics simulator. The library will permit repeated deliberate practice on cases that exhibit a range of normal and abnormal anatomies, facilitating the transfer of skills to live surgical procedures. In order to establish the efficacy and impact of the program, the performance of each participant will be assessed on the simulator as well as in live surgery before and after the intervention. The results of this have important implications for the use of simulation during neurosurgical training. If successful, future research will extend the application of the simulation model to the training of other clinicians who perform this procedure under emergent circumstances and to determine if practice on complex cases translates into improved performance in the field. [unreadable] [unreadable] [unreadable]